INSURANCE CLAIMS ADJUSTER RESUME EXAMPLE

Published: Oct 06, 2025 - The Insurance Claims Adjuster reviews and evaluates insurance claims by assessing coverage eligibility, policy status, and supporting documentation. This role conducts investigations into contestable or potentially fraudulent cases, determines benefit eligibility, and recommends claim approval or denial. The adjuster also manages complex caseloads with minimal supervision while coordinating with vendors, legal entities, and clients to ensure accurate and compliant claim resolution.

Tips for Insurance Claims Adjuster Skills and Responsibilities on a Resume

1. Insurance Claims Adjuster, Horizon Mutual Insurance, Des Moines, IA

Job Summary: 

  • Proactively investigate and perform in-house adjustments of claims
  • Ensure claims are handled within authority limits, and in line with Route standard procedures and guidelines
  • Drive third-party service providers to achieve cost-effective results and to provide a high-quality service to all internal and external customers
  • Training and development for other claims handlers
  • Work with senior management on the development of the claims administration system
  • Input and maintain accurate claims records for designated accounts
  • Timely production of management information reports (e.g., monthly major claims movements) and proactively identify loss trends
  • Investigate standard/complex claims, including coverage determination and evaluation of loss exposures
  • Settle standard/complex claims through payment or denial
  • Support subrogation/salvage processes


Skills on Resume: 

  • Claims Investigation (Hard Skills)
  • Loss Evaluation (Hard Skills)
  • Policy Compliance (Hard Skills)
  • Data Management (Hard Skills)
  • Report Production (Hard Skills)
  • Team Leadership (Soft Skills)
  • Vendor Coordination (Soft Skills)
  • Trend Analysis (Hard Skills)

2. Insurance Claims Adjuster, Silverline Risk Solutions, Knoxville, TN

Job Summary: 

  • Accurately interprets policy language and executes accordingly
  • Documents rationale for claim direction
  • Timely handling of mail and correspondence
  • Communicates with claimants/representatives via phone, e-mail, letter or fax
  • Handles incoming calls and returns voice mail messages promptly
  • Manages daily reports to ensure productive claim handling
  • Serve as the Insurance point of contact with customers
  • Directing and making decisions regarding the repair process from beginning to end
  • Complete vehicle inspections, write estimates, determine total loss evaluations, and set clear expectations and timelines


Skills on Resume: 

  • Policy Interpretation (Hard Skills)
  • Claim Documentation (Hard Skills)
  • Customer Communication (Soft Skills)
  • Time Management (Soft Skills)
  • Decision Making (Soft Skills)
  • Report Management (Hard Skills)
  • Vehicle Assessment (Hard Skills)
  • Process Coordination (Soft Skills)

3. Insurance Claims Adjuster, Prairie Valley Insurance Group, Wichita, KS

Job Summary: 

  • Negotiate the repair process with body shops
  • Document information related to the claim and make decisions consistent with claims standards and local laws
  • Evaluate and handle claim payments and the resolution of claims without payments
  • Review and determine the validity of any supplement requests
  • Providing effective claims management and settlement services through direct and indirect customer contact and the appropriate management of designated third-party vendors and service providers
  • Settle and/or manage claims that require a higher level of complexity/delegated authority than claims administered by Claims Case Managers
  • Assist in the investigation of and finalisation of complex claims 
  • Provide input and guidance on claims administered by Claims case Managers to facilitate effective claims management and settlement


Skills on Resume: 

  • Negotiation (Soft Skills)
  • Claims Evaluation (Hard Skills)
  • Payment Processing (Hard Skills)
  • Supplement Review (Hard Skills)
  • Vendor Management (Soft Skills)
  • Complex Claims Handling (Hard Skills)
  • Investigative Support (Hard Skills)
  • Guidance Provision (Soft Skills)

4. Life Insurance Claims Adjuster, Atlantic Shore Assurance, Wilmington, DE

Job Summary: 

  • Accurately process claims under Life Insurance coverage
  • Evaluate claim submission, determine policy benefits and request additional information to finalize claim
  • Manage pending files and create claim-related correspondence
  • Interface with Policyholders and Agents, answering a variety of questions through different service channels such as phone, email and web
  • Manage continuing waiver of premium claims
  • Assist in the preparation of SIU cases and the preliminary investigation of suspected fraud
  • Meet Department metrics for time service and quality
  • Build a broad understanding of products and systems
  • Ability to maneuver between system applications confidently to find information and respond to customer needs promptly
  • Collaborate with others to ensure effective resolution of customer needs, follow-up and workflow


Skills on Resume: 

  • Claims Processing (Hard Skills)
  • Benefit Evaluation (Hard Skills)
  • File Management (Hard Skills)
  • Customer Interaction (Soft Skills)
  • Fraud Investigation (Hard Skills)
  • Performance Tracking (Hard Skills)
  • System Navigation (Hard Skills)
  • Team Collaboration (Soft Skills)

5. Life Insurance Claims Adjuster, Redwood Coverage Services, Modesto, CA

Job Summary: 

  • Reviews coverage eligibility, policy status, and requests necessary proof of loss documents
  • Reviews and evaluates claim proofs
  • Conducts contestable investigation 
  • Reviews medical records, determines benefit eligibility and recommends claims for payment or denial
  • Primarily handles a Contestable claims caseload
  • Directs vendor investigations to secure medical records, criminal records or other information
  • Identifies possible fraudulent claims and refers to the necessary agency/department
  • Acts in a leadership and supervisory capacity and can mentor and train
  • Performs many functions with limited or no direct supervision
  • Interacts by telephone and written correspondence with all levels of sales force, clients, attorneys, regulators, law enforcement officials and vendors


Skills on Resume: 

  • Coverage Evaluation (Hard Skills)
  • Claims Assessment (Hard Skills)
  • Contestable Investigation (Hard Skills)
  • Fraud Detection (Hard Skills)
  • Vendor Oversight (Soft Skills)
  • Leadership Ability (Soft Skills)
  • Independent Work (Soft Skills)
  • Professional Communication (Soft Skills)
Relevant Information
Insurance Claims Specialist Resume Example